Healthcare Provider Details

I. General information

NPI: 1902406549
Provider Name (Legal Business Name): HERMITAGE DIRECT PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 06/06/2021
Certification Date: 06/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

357 RIVERSIDE DR STE 260
FRANKLIN TN
37064-8974
US

IV. Provider business mailing address

1443 LONG HOLLOW PIKE
GALLATIN TN
37066-8589
US

V. Phone/Fax

Practice location:
  • Phone: 615-206-8668
  • Fax:
Mailing address:
  • Phone: 615-922-8029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NICOLE PAIER-MULLAN
Title or Position: OWNER
Credential: MD
Phone: 615-206-8668